Our guide- Madam Mrs.

Shanthi
Veera

ANITHA
ANJAN
ANJU
ANN MARY
ANNA
ANU P
ANU S
ARCHANA
ASHLEY
BLESSY
 CASE PROFILE
Mr. V.M. is a 39yr old African-American man who has a SCD,
sometimes called sickle cell anemia, marked by frequent
episodes of severe pain. His anemia has been managed with
multiple transfusions and he shows signs of chronic renal
failure. He is a non-smoker, non-drinker and is on social security
disability. His regular medications are pentoxifylline(trental),
oxycodone/acetaminophen and folic acid. In hematology clinic
this morning, V.Ms hb measured 6.7g/dl. He received two units
of PRC over 3hrs and then went home. He developed
dyspnoea and SOB approximately 1-11/2hrs later and his wife
called 911. The EMS crew initiated oxygen and transported V.M
to the ED.
 BASE LINE DATA

NAME: Mr. V.M.

AGE :39yrs old
SEX : Male
MARITAL STATUS: Married
DIAGNOSIS: SCD
 CASE WORK
PROBLEMS IDENTIFIED
PROBLEM SOLVING QUESTION
PROBLEM ANALYSIS
 DEFINITION
SICKLE CELL ANEMIA IS AN
AUTOSOMAL GENETIC DISORDER
AFFECTING RECESSIVE
INDIVIDUALS.
 HISTORY

PAST MEDICAL HISTORY

PRESENT MEDICAL HISTORY
 DIFFERENCES
NORMAL RBC SICKLED RBC
120 days of life
30-40 days of life
span
span
Normal oxygen
Less oxygen carrying
capacity
carrying capacity
6-9 gm of Hb/ml
12-14 gm of hb/ml
Sickled Hb is Hb s
Normal Hb is HbA
Destroy at acclerated
Destroy at normal rate
rate
ANATOMY AND PHYSIOLOGY

Anatomy of RBC
Physiology of RBC
RBC life cycle
Erythropoiesis
Destruction of RBC
 ETIOLOGY
HERIDITARY
 CLINICAL
MANIFESTATIONS
CENTRAL NERVOUS SYSTEM
Thrombosis
Hemorrhage related paralysis
Cerebral deficits
Death
 CARDIAC
Systolic murmur
Cardiomegaly
Heart failure
RENAL
Hematuria
Renal failure
 SPLEEN
Spleenomegaly
Splenic atropy
HEPATIC
Hepatomegaly
Gall stones
GENITAL
penal priapism
SKELETAL
Hand-footsyndrome
Osteonecrotic skeletal deformities

Osteomyelitis

Osteoporosis

DERMIS
Stasis ulcers of the extremities
 OPTIC
Hemorrhage
Retinal detachment
Retinopathy
Blindness
 1. HEMATOLOGICAL
INVESTIGATIONS
Hemoglobin
Hematocrit
Serum iron
Reticulocyte count
Erythrocyte count
E.S.R
Total iron binding capacity
W.B.C count
2. SICKLE CELL PREP
3. SICKLEDEX
4. HEMOGLOBIN ELECTROPHORESIS
5. ANTENATAL DIAGNOSIS
it is available to the high
risk group through amniocentesis
 OTHER DIAGNOSTIC
TEST
X-Ray
Electro cardiography
Ultra Sonography
Computed Tomography
Magnetic Resonance Imaging
Abdominal Sonogram
 TREATMENT
1.PREVENT SICKLING
Promote adequate oxygenation and
hemodilution.
2.CRISIS EPISODES.
Aplastic episodes
Splenic sequestration
Hemolytic episodes
 Vaso-occlusive or painful episodes.
Hydration.
Analgesics.
Alternative pain management.
Infection.
Antibiotic prophylaxis.

Bone marrow transplantation.

treatment.
 PREVENTION

Protect the client from infection.

Genetic counseling.
Health education to public.
SICKLE CELL CRISIS
 COMPLICATIONS
SPLENIC SEQUESTRATION
APLASTIC CRISIS
HEMOLYTIC CRISIS
BONE CRISIS
ABDOMINAL CRISIS
C.N.S COMPLICATION
INFECTION
 CHRONIC BONE COMPLICATION
PULMONARY COMPLICATION
PRIAPISM
LEG ULCER
CARDIAC COMPLICATIONS
 RENAL COMPLICATION
Hypostenuria
Nocturia

Hyperkalemia

Hematuria

Pyelonephritis

Intermittent hypertension

Nephrotic syndrome

Chronic renal failure

MEDICAL MANAGEMENT
NON-PHARMACOLOGICAL
MANAGEMENT
PHARMACOLOGICAL MANAGEMENT
 SURGICAL
MANAGEMENT

SPLEENECTOMY
 NURSING
MANAGEMENT
HISTORY COLLECTION
PHYSICAL ASSESSMENT
NURSING CARE
-minimization of energy expenditure
and use of oxygen
-promotion of hydration
-circulatory over load
-Circulatory overload
- Monitor vital signs
- Air embolism
- Relief of pain
- Remove any constrictive clothing
-Check capillary refill,peripheral pulse
 Nursing diagnosis
1) Pain related to sickling crises
2) Ineffective breathing pattern,dyspnea
related to decreased O2 supply to the lungs
3) Hypoxemia related to decreased
hemoglobin
4) Altered oral mucous membrane related to
decreased oral intake.
5) Sexual dysfunction related to fatigue,pain
and fear of pregnancy.
6) Self-esteem disturbances related to loss of body
functions,change in life style.
7) Activity intolerance related to decreased O2
transport.
8) Impaired physical mobility related to activity
limitations imposed by current diagnosis.
9) Knowledge deficit related to lack of
exposure/recall and unfamiliarity with
information sources.
10) Anxiety related to unfamiliar environment.
signs and symptoms of SCD,lack of understanding
of diagnostic test, diagnosis,treatment.
11) Enhanced therapeutic regimen management
related to disease treatment and prevention of
crisis.
12) Risk for infection related to spleen dysfunction,
inadequate primary defense and inadequate
secondary defenses.
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Kliegman,Fenson;16TH edition,A Harcourt
publishers international company;pg
no:14792-1482
2. Wong's essentials of pediatric nursing;
Marilyn's Hockesberry;7th edition; elseviers
publications;pg no:944-945
3. Text book of pediatrics nursing;Dorothy R
Marlow,Barbara A Redding:6th edition,reed
elseviers publications pg no:652-653
4. A Short text book of pediatrics;Suraj
Gupte;10th edition; jaypee brothers;Medical
Publishers;pg no:466-467
5. Medical surgical nursing across the health
care continuum:Donna D
Ignlaviccus,MlindaWorkman,Mary A
Mishler:volume 1 3rd edition pg no:951-983
6. Medical Surgical Nursing;Joyce M
Black,Jane Holcanson Hawks Volume
1&2,pg no: 2294-2299,941-972
7. Medical Surgical
Nsg;Ignatavicius,workman; 5th edition,
Pg no:894-895
8. Medicine for students;A F
Golwalla;16th edition; pg no:487-489
9. The Lippincott manual of nsg
practice;6th edition;pg no:1327-1330
10. Brunner & Suddarths text book of medical
surgical nsg;Suzanne C Smeltzev;9th edt pg
no;746-750
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Phipps,Barbara C Long,Nancy Fujate 7th
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Linda Workman 5th edition; pg no;888-891